Hyperhidrosis or excessive sweating is a common condition that affects up to 3% of the population. The hot humid weather of Brisbane can make this condition both uncomfortable and embarrassing. Dr Davin Lim is an expert in the management of underarm sweating and has performed over 5000 injection procedures to help thousands of people locally, overseas and interstate. Did you know that Medicare subsidises up to 3 anti-sweat treatments per year- under the Specialist Dermatologist scheme?
- Axillary hyperhidrosis or excessive underarm sweating is a very common condition in Queensland
- The hot and humid weather Brisbane can make hyperhidrosis unbearable both physically and psycholocially
- You should consider treatment if it bothers you socially or restricts what you wear- most suffers wear black
- There are 2 reliable treatments for underarm sweating- anti sweat injections and miraDry
- Anti sweat injections last between 4-12 months and are heavily subsidised by Medicare
- The choice of what is the best treatment will depend on your lifestyle, age and type of sweat reduction you want
- Sweat treatments are very affordable as they are subsidised by Medicare- treatment is around $2 a day, less than a cup of coffee
Excessive underarm sweating or axillary hyperhidrosis is more common than you think. 4 out of 100 people suffer from this condition. The cause is genetic, however this condition is worsened with stress, drugs (such as anti depressants) but most importantly caffeine – found in coffee and energy drinks. There are only 2 questions that determine if you require treatment for excessive underarm sweating. Firstly- does this condition affect your confidence when you lift your arms up? Secondly, does sweating limit what you wear? If so, this is a MEDICAL and not a cosmetic condition that can be treated. There are several options for effective management, however the video below shows the first step should you fail over the counter antiperspirants such as DRICLOR. This treatment is partially covered by Medicare, providing you fulfil the required criteria. (Namely trial of Driclor, history of sweating, and impact on your life). Video tells the story.
The cause of hyperhidrosis is genetic, made worse with stress, drugs and caffeine. There is a one in four chance of passing your excessively sweat genes to your children. Some drugs, such as anti-depressives also worsen underarm sweating. One of the biggest contributing factors I see, is stress.
If you are reading this sentence or doing research on sweating and sweat reduction methods, chance are you may benefit both psychologically and physically from treatment. I ask two questions only if anti-sweat treatments can help you. Firstly, does sweating limit what you wear? Most people who sweat a lot wear clothes to hide their sweating- usually black or white. Secondly, do you feel uncomfortable in public places- examples including lifting your arms above your head in public, or just thinking if people notice your sweat patches. If you do, then sweating is definitely impacting your psyche.
For more in depth assessments and a score of you over all rate, I have devised a set of questions to further explore the need for anti-sweating treatments. In 2012 I wrote an entire web portal on sweat treatments providing information and contacts as to where to get the best treatments under a sweat specialist. This domain is called Sweat Free. More on this questionnaire at www.sweatfree.com.au
Anti-sweat treatments start off with over the counter antiperspirants, and finish up with surgery. I will discuss the treatment ladder that ranks sweat treatments from the bottom up.
- Over the counter antiperspirants. My favourite ones for mild sweating include Rexona Sport and Dove Clinical. Next up is Driclor. This is super strong, and following the instructions on the packaging will reduce the chances of skin irritation. Driclor may not work for people with moderate to severe underarm sweating.
- Anti sweat injections. Treatment takes 90 seconds, and involves 10-20 needles in each armpit. This treatment works well in over 95% of cases and last between 4-8 months. It works out to an average cost of $2 per day to be sweat free.
- miraDry. I was the first Doctor in Australia to be trained in this procedure. 2 treatments, 2 months apart will give sweat reduction that is permanent. Expect 80% reduction in the amount you sweat. Even though I perform 2-3 of these procedures per week, I encourage patients to carefully think about miraDry, as it reduces not totally eliminates sweating. miraDry is the treatment of choice for patients who seek a ‘normal sweat pattern.’
- Tablets such as propanthelene bromide or Oxybutin- these are prescribed by your GP, and can be used for short periods, say a few weeks or months. They can be effective.
- Surgery or ETS (endoscopic thoracic sympactemomy) is performed by a vascular surgeon in a major operating theatre. This is the last line treatment for underarm sweating because it can cause rebound sweating that is unpredictable and permanent. I do not recommend this treatment, unless all else has failed.
Bottom line- start with antiperspirants, and if they don’t work, consider anti sweat injections as these are subsidised by both Medicare and the PBS- providing they are performed by a Dermatologist.
miraDry can permanently reduce sweating by up to 70- 80%, but unlike Botox treatments, this is NOT covered under Medicare.
Anti sweat injections are only indicated if topical solutions fail- namely Driclor. Here are the important facts about injections and sweating-
- Treatment takes 90 seconds for underarm hyperhidrosis
- Each injection feels like an ant bite, and is well tolerated
- Local numbing cream can reduce pain by up to 90%
- Injections last between 4-8 months, the average being 6 months
- The treatment is subsidised by Medicare and PBS, and the out of pocket cost is $440
- 3 treatments are subsidised per year- providing they are done by a Specialist
- 100 units are used to treat underarm sweating
- Side effects are very, very rare. Bruising and swelling may occur in 5% of cases.
- After anti sweating injections you can resume exercise 24 hours later
- Sweating will start to decrease by 70-100%, within 7 to 10 days
- This treatment is extremely safe, I have performed over 5000 cases over the past 12 years
- It is approved by all health authorities and governing bodies in the US, Europe and the TGA in Australia
- If sweating really bother you, anti sweat injections works well in over 95% of cases
- The 5% that fail injections will usually have anxiety issues, these can be address with cognitive behaviour therapy
- I prefer to use anti sweat injections as the stepping stone to miraDry treatment for underarm sweating
- Injections can also be used to treat sweaty hands and feet, however I discourage this use due to the cost- $2500. Anti sweat injections are NOT subsidised for treating sweaty hands and feet, only for underarm sweating. For sweating of the hands and feet known as palmar and plantar hyperhidrosis, iontophoresis is the treatment of choice
Each injection feels like an ant bite. 99% of patients tolerate the procedure very well, as it is all over within 90 seconds. Dr Davin Lim has been voted as one of the most painless injectors – he places small amounts of anti sweat injections at a very superficial level- unlike other specialist who perform this as a ‘deep procedure’. The more superficial and slower the injection, the less pain is felt.
For patients with pain hypersensitivity, we use a special numbing cream that decreases pain by up to 90%. If a special cream called 23/7 is used, the procedure can be painless.
Unlike Botox injections miraDry is a permanent solution for underarm or axillary hyperhidrosis. This treatment is a two-stage procedure, namely a second treatment needs to be performed 2 months after the first.
miraDry is the only treatment that produces a ‘normal sweat pattern’ for patients- namely it reduces but not eliminates sweating. This is NORMAL. The problem with Botox is 3 fold- firstly it may work too well, namely it stops underarm sweating all together. Secondly patients often get stressed when it stops working (and stress worsens sweating). Anticipation of when it will cease to work is always on the mind of patients. Thirdly it is not permanent – some patients may only get 6 weeks out of it, whilst others 14 months. The average user gets just over 6.3 months relief. The flipside is that Botox is safe, effective in over 95% of cases, takes 90 seconds to perform and on average cost only $2 a day, as it is subsidised by Medicare.
miraDry is permanent, thus once the two treatments are done sweating permanently decrease by up to 50-80%. No more injections, no more anticipation, and in theory, no more anxiety about sweating. The downside? Cost- the entire treatment course is around $3700, and it is not subsidised by Medicare. Additionally there is down time, namely swelling for up to one week. (More than what is stated by the company)
What do I prefer? I do not have a preference, I think Botox is a great entry level treatment for axillary sweating, as it is cheap, subsided by Medicare, and it works. If you are after a permanent solution and can accept a 50-80% reduction of sweating- miraDry maybe the solution for you. Every sweater is different. IMO, miraDry is a first generation device that is over 4 years old, second generation miraDry is in development, and as an advisor, I would wait for this to arrive (prediced 2018- knowing Australia’s snails- pace TGA regulations- Australia is one of the LAST first World countries to receive medically approved equipment.)
I authored the miraDry website- for all the info on miradry go to www.miradry.com.au
More on this treatment in the video below.
Additionally I founded the webportal called sweatfree, this provides all the information needed for sweating, including sweaty hands, feet, underarms, and face. The webstie is www.sweatfree.com.au
Botox injections are subsidised by both PBS and Medicare. The out of pocket cost for treatment is $440. Considering the average user will be sweat free for 6 months, it averages out to just over $2 a day. The reason why injections are a lot cheaper, is that Dr Davin Lim is an accredited injector, recognised by Medicare as a Specialist in the field of hyperhidrosis/ sweating.
miraDry treatments are not subsidised by Medicare, nor are they subsidised by private health insurance. The course of treatments for underarm sweating is $3700- this includes 2 treatments, spaced 2 months apart.
Dr Lim stared performing Botox for underarm sweating in 2001, 15 years ago and has performed over 5500 cases of underarm Botox.
He performs up to 6 procedures on a daily basis.
Dr Lim was the first Specialist in Australia to undertake miraDry training in April 2014, well before the TGA launch date in August of that year.
He is also a leading member of the International Hyperhidrosis Society, and a National trainer for Botox injections for sweating in Australia. Additionally he founded and authored a web portal for the treatment of excessive sweating called sweatfree.com.au
Why is a laser and cosmetic dermatologist performing sweat treatments I hear you asking? It is because I am comfortable with Botox, additionally I understand the psyche of excessive sweating, and how it affects people’s life. The fact that I can help, and in some cases cure this condition is rewarding. Now that this is under Medicare, it makes anti-sweat treatments more affordable for all patients. It really does equate to around $2 a day to be sweat free!
Before anti sweat injections, patients must have a trial of antiperspirants such as Driclor. This is part of the Medicare rules for the treatment of excessive underarm sweating.
If Driclor is too irritating, I recommend Rexona or Dove Clinical. Most patients who have moderate to severe underarm sweating will not tolerate Driclor, or fail to respond to the recommended antiperspirants, hence injections or miraDry are the only solutions.
Yes, however all consultations for this form of sweating goto the Sweat Free institute. I wrote the protocols for a treatment known as glyco ionto, and this is performed at Westside Dermatology. For more information on this treatment, call 07 3871 34 37 and make a booking with Nigel Harris.
As a rule I do not encourage injections for hands and feet UNLESS the procedure is covered by your insurance. Only International health insurance covers this procedure. Medicare and Private Health Insurance in Australia will not cover anti sweat injections for sweaty hands and feet.
Dr Davin Lim performs BOTOX injections for excessive underarm sweating at the following places-
Westside Laser Dermatology – 07 3871 34 37
miraDry is only performed at Westside Laser Dermatology. For all other forms of anti-sweat treatments, booking in with the head nurse practitioner, hyperhidrosis unit at Westside Dermatology- Nigel Harris. Nigel treats other forms of sweating such as sweaty hands, feet, general sweating, scalp sweating and compensatory HH.
By Dr Davin Lim
Founder of Sweat Free Australia
I see several patients per day for this condition, and have a passion treating it. Stopping excessive sweating changes lives. I founded and wrote the website known as Sweatfree – an information portal and directory for Specialists who provide anti-sweat treatments in Australia.
Patients look forward to Botox injections as it gives them confidence. Hyperhidrosis does not discriminate – it affects lawyers, sales managers, company directors, students and even military personnel, and it affects them equally. It can cause both physical as well as psychological distress and can really rock your confidence. Sweaty patches don’t go down well in a job interview or a presentation.
Patients who see me would have all trialled, and failed Driclor, and hence I perform Botox as the first line treatment for excessive underarm sweating. My suggestion is Botox first before miraDry, because if you are lucky, you may have up to 12 months of no sweating- most people start off with 4 months, then push upwards to 6.
When do I use miraDry? Well, the treatment is hampered by costs- that is the bottom line. Botox is subsidised by both the PBS and Medicare, and averages to $2 a day to be sweat free. miraDry is $3700. This is an excellent and permanent treatment and reduces underarm sweating by up to 80%. I let patients decide which treatment suits them.